1_Eosinophilic_Lung_Disease_Part_1_Background_and_Classification.pdf

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rambhoopal1

eosinophil lung disease

Health & Medicine

Eosinophilic Lung Disease
Stephanie M. Levine, MD, FCCP
University of Texas Health-San Antonio
South Texas Veterans Health System

Conflict of Interest Disclosure
•No relationships exist with industry ne

Overall Learning Objectives
• To review the major eosinophilic pulmonary disorders
• To be able to distinguish acute and chronic eosinophilic
pneumonia (AEP and CEP)
• To be familiar with common presentations of AEP, CEP, Allergic
Bronchopulmonary Aspergillosis (ABPA), Eosinophilic
Granulomatosis with Polyangiitis (EGPA, Churg- Strauss
Syndrome), Hypereosinophilic Syndrome

Eosinophilic Lung Disease- Part 1
Stephanie M. Levine, MD, FCCP
University of Texas Health-San Antonio
South Texas Veterans Health System
Part 1
Background and Classification
• Objectives- To review the major eosinophilic pulmonary disorders

• Cytokines that stimulate growth, differentiation, and
production of eosinophils: IL-5, IL-3, GM-CSF
• Only IL-5 is specific for eosinophils
Granules contain:
-MBP (major basic protein)
-Eosinophilic cationic
protein
-Eosinophil derived
neurotoxin
-Charcot-Leyden crystal
protein

Definition
• A heterogeneous group of disorders characterized by increased
numbers of eosinophils in 1 or more compartments of the lung and/or
blood
• Radiographic abnormalities
• Impaired pulmonary function
• +/- peripheral eosinophilia
• The role of the eosinophil in many of these diseases differs and is not
well characterized
• Good guy vs bad guy vs bystander

Classification- based on anatomical
location
• Airway
• Asthma
• Eosinophilic bronchitis
• Allergic bronchopulmonary aspergillosis
• Bronchocentric granulomatosis
• Parenchyma
• idiopathic (primary) vs known cause (secondary)

Primary Eosinophilic Disorders
• Lung limited
• Acute eosinophilic pneumonia
• Chronic eosinophilic pneumonia
• Systemic
• Hypereosinophilic syndrome
• Eosinophilic Granulomatosis with Polyangiitis
(EGPA) or Churg-Strauss Syndrome

Secondary Eosinophilic Disorders
• Airway centered
• Allergic bronchopulmonary aspergillosis
• Infections- parasites, bacterial, fungal (aspergillus, coccidioides)
• Vasculitides
• Drugs/Toxins
• Malignancy- lymphoma, lung cancer, leukemia, MDS
• ILD- HP, LCH, COP, sarcoidosis

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All drugs taken in the weeks or months preceding the syndrome of eosinophilic pneumonia (EP) must be thoroughly investigated, including illicit drugs. Medications that are commonly known to cause drug-induced EP include nonsteroidal anti-inflammatory drugs, antibiotics such as trimethoprim-sulfamethoxazole, penicillin, nitrofurantoin, minocycline, angiotensin-converting enzyme-inhibitors, sulfa drugs, and ethambutol.

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Cardiology/Endocrine Case Study Course Student Learning Outcomes Upon completion of the case study, students will be able to … 1. Apply the principles of pharmacology relative to pharmacotherapeutics across age levels including the effect of race, gender, ethnic group, and special populations. 2. Describe the uses, actions, effects and nursing implications of general classifications of drugs and selected specific drugs. 3. Investigate media resources and information technologies to enhance knowledge base of pharmacology. 4. Analyze the responsibilities of the nurse when administering drugs. 5. Apply pharmacological research to nursing practice. Purpose The purpose of this case study is to apply concepts from pharmacology and pathophysiology, national guidelines, and evidenced based clinical practices in the management of chronic disease. Remember this paper must follow APA guidelines for font, in text citations, reference list etc. No abstract is needed. Provide headings for the different questions in your paper. Setting This case study takes place in a primary care setting in a small rural hospital clinic that provides health care services to predominately Latino field workers and their families. The rural clinic serves children and adults for all medical needs including well care, acute care, and chronic conditions. Some clients have seasonal insurance, state health insurance, or no insurance. Many live below poverty level according to the federal guidelines. Most do not own a vehicle. Most do not speak English; so, a translator is provided at each visit. The clinic is one hour from the nearest city where higher level of care can be offered to patients in need of specialty care. The clinic is staffed by one family medicine physician, an internist, two nurse practitioners, an RN, two LVNs, a lab tech, eight MAs and support staff. Once a week a cardiologist, podiatrist, pain specialist, orthopedist and ophthalmologist service the clinic. There is an on-site lab and a pharmacy two blocks away. There are two ambulances servicing the entire south end of the county with poor availability for emergencies. Client Jose is a 47 year old morbidly obese Latino male who presents to the clinic for follow up evaluation of headaches, dizziness, ringing in his ears and frequent urination. He reports having a headache that “comes and goes” with ringing in his ears and sometimes he sees spots. Jose has taken acetaminophen and states that seems to help. Due to his work schedule of six 12 hour days, Jose has not had preventive care. He reports fatigue and is depressed regarding his current income situation. Jose has just been laid off for the season and will lose his insurance in 30 days until the restart of the harvesting season in March. He is concerned about paying for any health care that may go beyond his benefit period. Jose lives with his pregnant wife, who does not work, and their seven children in a three bedroom one bath house that they share.

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